LIMITATIONS OF PERONEAL ARTERY BYPASS-GRAFTING FOR LIMB SALVAGE

Purpose: The purpose of this study was to compare the results of peron eal bypass grafting for limb salvage with the results of other tibial and pedal bypass grafts performed concurrently. Methods. Thirty-four p eroneal bypass grafts with autologous vein were performed for limb sal vage between September 1986 and June 1992. These constituted 18% of an overall experience of 194 tibial or pedal bypasses performed during t hat time. Preoperative and intraoperative arteriograms were reviewed t o identify anatomic characteristics associated with successful limb sa lvage. Results. Secondary patency rates for peroneal bypass grafts (70 %) compared with the other tibial and pedal bypass grafts (65%) did no t differ significantly at 48 months by life-table analysis. Limb salva ge achieved by peroneal artery bypass grafting was significantly worse (55%) than that achieved by the remaining tibial and pedal bypasses ( 67%) at 48 months. Limb salvage was 33% at 7 months for those undergoi ng peroneal artery bypass grafting as opposed to 57% at 48 months for patients undergoing other tibial or pedal revascularizations with tiss ue necrosis. Four anatomic features were identified that were associat ed with failure after peroneal artery bypass grafting. These were pero neal length less than 10 cm (p = 0.012), peroneal artery diameter less than 2 mm (p = 0.035), absence of arteriographically demonstrated col laterals perfusing the foot (p = 0.0001), and little or no visualizati on of the pedal arch (p = 0.008).Conclusions: Although successful graf ts may avoid amputation in carefully selected cases, alternatives to p eroneal artery bypass grafting should be considered when less than fav orable anatomic conditions are encountered, particularly in the presen ce of forefoot tissue necrosis.